Zwiegelaar Su-Ané, Abraham Deepthi R, Roman Olivia, Welman Karen E
Division of Movement Science and Exercise Therapy, Department of Sport Science, Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa.
The Movement Laboratory, Sport Science Department, Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa.
Clin Case Rep. 2024 Dec 10;12(12):e9678. doi: 10.1002/ccr3.9678. eCollection 2024 Dec.
A 16-year-old male with hypermobility spectrum disorder (HSD) and Raynaud's phenomenon (RP) was referred to a clinical exercise physiologist (CEP) by their pediatric rheumatologist. The patient presented with arthralgia in the left knee and shoulder. Specifically, the left knee presented discomfort during activities of daily living (ADL), and the left shoulder had a reduced range of motion resulting from pain. Finally, complaints of painful fingers were also significant due to increased RP flare-ups during winter. A posture analysis was conducted, indicating relatively poor posture. Range of motion and manual muscle testing were suboptimal in the shoulders, but optimal in the knees and hips. The Kendal test, patella compression test, and Clarke's sign were conducted due to knee pain. Functional tests included a pelvic bridge, squat, Neer's test, and wall push-up. Finally, the modified pediatric clinical test of sensory interaction in balance (mPCTSIB) was completed to determine the interaction between balance systems. Analysis of all the tests conducted above confirmed the diagnosis of HSD and also indicated scapula dyskinesia, supraspinatus impingement, and patellofemoral pain syndrome. Consequently, the CEP treatment focused on strengthening the foot, knee, and hip kinetic chain, as a 12-week home program, along with hand exercises as needed to aid in the pain and stiffness experienced during RP flare-ups. The physiotherapist treatment was more hands on in the use of myofascial release, electrotherapy, taping, and posture correction of the neck and shoulder over four in-house visits. Finally, a 6-month follow-up was conducted by the CEP, in which the patient showed improvement with a pain-free range of motion and the ability to optimally conduct ADLs.
一名患有高活动度谱系障碍（HSD）和雷诺现象（RP）的16岁男性被其儿科风湿病学家转诊给一名临床运动生理学家（CEP）。该患者表现为左膝和肩部关节痛。具体而言，左膝在日常生活活动（ADL）期间出现不适，左肩因疼痛导致活动范围减小。最后，由于冬季RP发作加剧，手指疼痛的主诉也很明显。进行了姿势分析，结果显示姿势相对较差。肩部的活动范围和手法肌力测试不理想，但膝盖和臀部的测试结果最佳。由于膝盖疼痛，进行了肯德尔试验、髌骨挤压试验和克拉克征检查。功能测试包括骨盆桥运动、深蹲、尼尔试验和靠墙俯卧撑。最后，完成了改良的儿科平衡感觉交互临床测试（mPCTSIB）以确定平衡系统之间的相互作用。对上述所有测试的分析证实了HSD的诊断，还表明存在肩胛运动障碍、冈上肌撞击和髌股疼痛综合征。因此，CEP的治疗重点是加强足部、膝盖和臀部的动力链，作为一项为期12周的家庭计划，同时根据需要进行手部锻炼，以缓解RP发作期间出现的疼痛和僵硬。物理治疗师在四次门诊治疗中更侧重于使用肌筋膜放松、电疗法、贴扎以及颈部和肩部的姿势矫正。最后，CEP进行了6个月的随访，患者在随访中表现出改善，活动范围无痛，并且能够最佳地进行ADL。
